Antibiotic prophylaxis needs to be given only in certain circumstances

EDITOR—In their lesson of the week Shuttleworth et al suggest that all patients with fractures involving the orbit should receive prophylactic antibiotics.1 These fractures are largely managed in maxillofacial surgery units, and the prescription of prophylactic antibiotics for all such cases is not routine.2 At least 500 patients with periorbital fractures are seen in our units in a year. Many more patients with undisplaced fractures of the periorbital region do not present to any medical practitioner, the fractures being self diagnosed as a bad black eye. In the past 25 years we have seen only two cases of orbital cellulitis following nose blowing after orbital fracture. This …